[Use of recombinant human erythropoietin preparations as a blood-saving method in neurosurgery].

The paper gives the results of the first clinical use of recombinant human erythropoietin (rhEPO) within the blood-saving program in neurosurgical patients with preoperative anemia of various genesis and predictable massive intraoperative blood loss. A course of effective therapy with rhEPO is shown to increase hemoglobin and packed cell volume rather rapidly in all patients prior to surgery. This made it possible to effectively apply other blood-saving procedures (isovolemic hemodilution and instrumental reinfusion of washed red blood cells) and to reduce the volume required for the use of donor transfused media in these patients. Various clinical aspects of the use of rhEPO in these patients are discussed.

[Reducing the frequency of fresh frozen donor plasma transfusion on the basis of the results of thromboelastographic study in neurosurgical patients with intraoperative blood loss].

The paper gives the results of a study of the time course of changes in the major laboratorily determined hemostatic parameters, as well as the main characteristics of a thromboelastographic curve in 95 neurosurgical patients who developed significant intraoperative blood loss at surgery. The patients were divided into 2 comparable groups: 1) a decision on fresh frozen donor plasma transfusion was taken only on the basis of laboratory parameters; 2) this was done on the basis of thromboelastographic data. In Group 2, the frequency of fresh frozen donor plasma transfusion proved to be 4 times less than that in Group 1. The use of thromboelastography to evaluate the hemostatic system during operations with a significant blood loss volume permits a reduction in the frequency of fresh frozen donor plasma, without deteriorating the results of treatment.

[Analysis of modern blood reinfusion apparatuses].

The paper gives a brief review of the engineering solutions now applied to the clinical use of a blood reinfusion procedure. It considers simple, transient, and sophisticated (automatic) blood reinfusion methods, their advantages and disadvantages, and the areas of their possible clinical application.

[Thromboelastography as a method for preoperative screening for the hemostatic system in neurosurgical patients].

The paper analyzes the use of a method of thromboelastography (TEG) as a screening technique of diagnosing hemostatic disorders in risk-group neurosurgical patients: hemostatic disorders detectable from the data of routine laboratory tests; the administration of anticoagulants and desaggresants, the use of anticonvulsants causing impairments in the hemostatic system, hematological diseases, and hepatic cirrhosis. As compared with the routine laboratory tests, TEG is shown to diagnose hemostatic disorders accurately and promptly and to monitor the efficiency of their therapy.

[A case of early postoperative posttransfusion-associated lung injury (TRALI) in a female patient with giant intracranial meningioma and massive intraoperative blood loss].

The paper describes a case of the relatively rare complication transfusion-associated lung injury (TRALI) in the early postoperative period in a female patient who has experienced intraoperative massive blood loss and blood transfusion. It also considers the causes of this complication, its clinical symptoms and differential diagnosis, as well as a package of therapeutic measures and possible lines of prevention.

[Surgical treatment of extensive craniofacial juvenile angiofibromas].

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor occurring almost exclusively in adolescent and young adult males. The tumor is characterized by slow progression, aggressive growth, high vascularization and increased rate of persistence and recurrence. From 2000 till 2008 29 consecutive male patients with JNA Fisch grade III and IV (intracranial extradural or intradural extension) were operated in Burdenko Neurosurgical Institute (Moscow, Russia). Most patients received different kinds of treatment before admission to the Institute. All patients underwent surgical resection using predominantly orbitozygomatic approach. Preoperative endovascular embolization was applied. Total removal was achieved in 86% of cases. Postoperative complications included osteomyelitis of the bone flap (4 cases), nasal CSF leak (1 case) etc. Recurrences were observed in 3 patients, all of them underwent repeated surgeries. 4 cases are presented (3 patients with Fisch grade IV tumor and 1 with grade III). Surgical treatment is the basic tactics in management of extensive JNAs. The authors recommend to use orbitozygomatic approach and endoscopic assistance.

[Rhinological aspects of endoscopic endonasal removal of hypophysial adenomas].

The authors analyse rhinological aspects of endoscopic endonasal transsphenoidal adenomectomy (EETA): a nasal operation, intra- and postoperative liquorrhea, liquorrhea-associated meningitis, postoperative nasal hemorrhage, local changes of nasal cavity anatomic structures; provide practical recommendations on management of the conditions many of which are life-threatening.

[Waking-up anesthesiology ward at a neurosurgery clinic: annual report]. / Palata probuzhdeniia otdeleniia anesteziologii v neirokhirurgicheskoi klinike: analiz rezul'tatov raboty za god.

The structure and main annual indices of the waking-up anesthesiology ward, Anesthesiology Department, Burdenko's Research Institute of Neurosurgery, Russian Academy of Medical Sciences, are addressed in the paper. Outfit, personal structure and the spectrum of the prevailing neurosurgery pathology related with the above ward functioning as well as the reasons due to which the patients are transferred to intensive care are under discussion.

[Porcine kidney extract contains a specific inhibitor of the ouabain-sensitive alpha2-isoform of Na, K-ATPase present in rat diaphragm fibres]. / Ekstrakt pochek svin'i soderzhit spetsificheskii ingibitor ouabain-chuvstvitel'noi alfa2 izoformy Na, K-ATFazy myshechnykh volokon diafragmy krysy.

In experiments on isolated rat diaphragm muscle, acetylcholine (100 nmol/l) hyperpolarized muscle fibres due to activation of the alpha 2 isoform of Na,K-ATPase. This hyperpolarization was blocked in a dose-dependent manner by ouabain (K0.5 = 8 +/- 4 nmol/l) as well as by a solution of porcine kidney extract (10 kDa cut-off filtration), with the K0.5 approximately equal to a 1:20,000-fold dilution. The inhibitory activity of the developed slowly over a period of 3 hours and, in contrast to ouabain, was still present after 1 hour of washing. Ouabain, but not the extract, inhibits Rb+ uptake in human erythrocytes that only express the alpha = 1 isoform of Na, K-ATPase. Our data suggest that in rat skeletal muscle the alpha 1 isoform of Na,K-ATPase is primarily responsible for ionic homeostasis, while the alpha 2 isoform provides a "regulatable" function and may be controlled by cholinergic stimulation and/or endogenous digitalis-like factors (EDLFs). Porcine kidney extract contains a factor (M. W. < 10 kDa) that selectively inhibits the rat alpha 2 isoform and differs from ouabain. Our experimental protocol can be used as a highly sensitive physiological assay for factors that selectively inhibit the alpha 2 isoform of Na,K-ATPase.

[Intraoperative reinfusion of erythrocyte mass in neuroanesthesiology]. / Intraoperatsionnaia reinfuziia éritromassy v neiroanesteziologii.

Automated reinfusion of autoerythrocytes prepared from blood lost during removal of tumors was the main component of transfusion therapy in 49 patients (52 operations) with brain tumors. All patients developed massive blood loss of 0.5-5 TCB during the intervention, reinfusion device cell saver C.A.T.S 2-02 (Fresenius, Germany) was used. Various aspects of clinical application of this method are discussed, its efficiency and factors affecting it are analyzed. Special attention is paid to time course of hemostasis values during automated reinfusion and the problem of tumor contamination of reinfused suspension. This latter problem was solved by using the last-generation leukocyte filter RC-400 Klev (Pall, Germany). Automated reinfusion of autoerythromass effectively compensated for massive intraoperative blood loss, on condition of correction of hemostasis disorders by fresh frozen plasma and purification of reinfused suspension from tumor cells by filtering through leukocytic filters. Moreover, our results indicate that utilization of cell saver is obligatory for some patients with supermassive hemorrhages.

[Symptomatology of circular depression and prediction of the efficacy of treatment with tricyclic antidepressants]. / Simptomatika tsirkuliarnoi depressii i predskazanie éffektivnosti lecheniia tritsiklicheskimi antidepressantami.

The problem of efficacy prediction for psychopharmacotherapy of depressions is of considerable interest and urgency in view of frequently occurring resistance to antidepressants. The purpose of the present study was to study the feasibility of predicting the effectiveness of depression therapy in manic-depressive psychosis (MDP), based on the cross-sectional analysis of the patient's history (the clinical picture of the patient's condition prior to therapy) with the help of multivariate statistics. Eighty-two patients suffering from MDP with a variety of depressive states were examined. In addition to traditional descriptions, the clinical findings were documented by employing a system of standard evaluation scales. The data obtained were processed using the technique of multiple stepwise discriminant analysis. The latter resulted in the derivation of a mathematical prognostic formula allowing the prediction of tricyclic antidepressants efficacy.

[Effect of lithium on the course of endogenous psychoses (several clinico-statistical relationships)]. / Vliianie litiia na techenie éndogennykh psikhozov (nekotorye kliniko-statisticheskie zavisimosti).

In 75 patients with a phasic development of endogenous psychoses the course of the disease before lithium treatment was characterized by statistically valid and successively increasing from attack to attack phenomena such as lengthening of attacks (phases) with a stable duration of the remissions and more frequent double phases. All of these phenomena were regarded by the authors as an unfavourable medicative pathomorphosis. The influence of lithium was expressed in the following symptoms: 1) prevention of hospitalization (56% of the cases); 2) significant shortening of the attacks (phases) and in some of the cases (19%)--their arrest; 3) transition from psychotic syndromes to cyclothymic; 4) a significant drop of double phases and a corresponding rise in the number of "pure" subdepressive states.